It’s all downhill after age 30.  It really is…as far as your body is concerned.  Try as we might to look youthful, your body is genetically programmed to wrap things up.  As far as our skin is concerned, it thickens until age 20, holds steady until 30, and then thins at a rate of 1% per year.

Honest Skincare Products

Skincare promises so much, but asking your skin to stop aging is an enormous undertaking.  And asking (begging?) it to look younger is even more daunting.  And so, our quest to look younger, or maintain our youth, begins with a search for honest products.  So many ingredients – like peptides, placenta, charcoal, and various berries – have no science behind their use.  In fact, the list of ingredients that have more than a few scientific publications supporting their use is very small.  The ones that have the most evidence include the not-so-sexy Vitamins C, A, and B3 (niacinamide) and fruit acids.  With that understanding, my concept of skin care is very simple.  I recommend protecting the skin in the morning with sunscreen and B3 and feeding the skin in the evening with the light sensitive Vitamins C and A.  I include fruit acids that remove dead skin and allow better penetration of the other active agents.

But don’t expect overnight results.  Even the most promising computer analyzed data are meaningless if you don’t actually look better.  Honest skincare takes 3 months to see real changes in the mirror and it’s the foundation for looking younger.  For more rapid results, there will be some downtime…and more expense.  Plastic surgeons have an ever-growing toolbox of drugs, peels, technology, procedures, and surgery that can help you look as good as you feel…or even better.

Fillers: It’s a Revolution

Let’s start with fillers.  Over a century ago, plastic surgeons might have made an incision in your thigh, scooped out fat, and used it to fill in depressions.  But it wasn’t until liposuction was introduced to America in 1983 that the procedure for “fat grafting” came into being.  Sort of like transplanting perennials in your garden, moving fat from one are of the body really does work…to a limited degree.  It’s been used to fill those skin folds on your face (nasolabial and marionette lines) and plump up deflated lips, buttocks, and breasts.  But fat is fragile, and much of it does not survive beyond a year.  We have yet to study women long term who have had many ounces of fat pumped into their bodies…my prediction is that the nonviable (yes, that’s a soft word for “dead”) fat won’t be pretty.  Having said that, small transfers of fat do work and are a good solution in the lips and nasolabial folds.

In 1981, you may not have paid attention to the big news in plastic surgery.  That was the year President Reagan was shot and the first AIDS case surfaced – but it was also the year that the first commercial injectable collagen was introduced.  And it rocked the aesthetic world.

Collagen is the major protein in our skin.  It’s our structural support – our leather.  It holds us together.  But it is responsible for that thinning of the skin as we age – and it disappears at a rate of 1% each year.  Plastic surgeons thought it would be great to simply replace it and some people still think that slathering it on your skin will help.   But your skin is designed to keep most things out and so those giant protein molecules don’t have a chance at penetrating.  So, we need to directly inject it into wrinkles.  And millions of women did have collagen injected – it did a good job at filling wrinkles and plumping lips, but it lasted only a few months and some women developed rheumatologic diseases from excessive use.

The next big news in fillers came in 2003, with the FDA approval of hyaluronic acid containing Restylane.  More flexible and longer lasting than collagen, hyaluronic acid truly defined the next two decades in plastic surgery.  Creatively injected filler not only can smooth wrinkles and folds, but it can hide jowls, build up lips, chins, and cheeks, fill in acne scars and hide unsightly tendons and veins on hands.  Truly remarkable, there are dozens of hyaluronic acid and other fillers on the market.  The new ones last longer than a year, do not cause any illness, and can even be dissolved if injected errantly.  The new fillers are so good that they drove the older collagen companies out of business.

Beware of Poorly Trained Doctors

I’ve developed a unique technique to artistically inject fillers into wrinkles, lips, folds, and depressions of the face, neck, chest, and hands, I inject many hundreds, sometimes thousands, of microdroplets to rejuvenate and restore.  Sounds painful, but along with anesthetic creams, I perform “dental blocks” numbing the mouth completely, allowing the clock to be turned back painlessly.  I teach my technique to residents training to be plastic surgeons at Columbia and Cornell Medical Schools, who are in turn becoming experts.  Fillers have truly revolutionized plastic surgery, but they seem deceptively easy, causing many non-plastic surgeons, even non physicians, to start injecting it, sometimes in storefront businesses.  Beware of poorly trained doctors – even the seemingly simple technique of filler injection can result in grotesque appearances, skin wounds, and even blindness or strokes.  You only need to watch the Oscars or walk around Manhattan or Beverly Hills to see what can happen when an amateur injects too much or in the wrong place.

Next time, let’s talk about the surgical procedures that I love to do to help women look better and younger without the stigma of surgery.

Arthur W. Perry, MD, FACS is a board-certified plastic surgeon with offices at 1021 Park Avenue in Manhattan, NY and Somerset, NJ.  He is the author of “Straight Talk about Cosmetic Surgery” and host’s WOR radio’s “What’s Your Wrinkle” show every Saturday evening at 6 pm.  His website is www.perryplasticsurgery.com.  He can be reached at (212) 753-1820.